We are recruiting for a mission-driven Grievance & Appeals Claims Specialist - Denver Health Medical Plan (Must Live in Colorado. Weekly On Site Requirement.) to join our team!
We're with you for life’s journey. At Denver Health, purpose isn’t just something we believe in—it’s something we live every day, for life’s journey.
Our Values
Respect | Belonging | Accountability | Transparency
Department
Managed Care Administration
* Must live in Colorado
* This is a hybrid role located in Denver, Colorado with a requirement of being in the office 2 days per week.
Job Summary
The Grievance & Appeals Claims Specialist is a key position responsible for handling and resolving client grievances and appeals regarding services and claims. This role ensures that all complaints are addressed promptly and accurately, maintaining compliance with regulatory standards and company policies. The specialist is an advocate for clients, working to resolve issues and improve overall satisfaction while safeguarding the integrity and efficiency of the organization.
Essential Functions :
Handle and resolve incoming grievances and appeals in a timely and efficient manner (20%)
Document all complaints, appeals, and resolutions accurately in the system. (20%)
Conduct thorough investigations to gather necessary information for resolving appeals. (10%)
Communicate effectively with clients, providers, and internal departments to resolve issues. (10%)
Ensure compliance with regulatory standards and organizational policies. (10%)
Collaborate with other departments to address systemic issues and prevent future grievances. (10%)
Provide regular updates to management on the status of grievances and appeals. (10%)
Analyze trends in claims grievances and appeals to identify areas for improvement. (10%)
Education :
High School Diploma or GED required
Associate's Degree preferred
Work Experience :
Associates degree and 1 year of claims, customer service, or grievance and appeals experience required
- Or -
3 years of experience in the insurance industry required . Claims preferred
- Or -
1 year of QNXT experience required
Licenses :
Knowledge, Skills and Abilities :
Strong knowledge of regulatory requirements and insurance products.
Excellent communication and interpersonal skills.
Proven analytical and problem-solving abilities.
Ability to handle sensitive and confidential information appropriately.
Proficiency in using relevant software and database systems.
Strong organizational and time-management skills.
Understanding of grievance and appeals processes.
Strong written and verbal communication skills.
Attention to detail and accuracy.
Ability to Ability to work independently and as part of a team.
Ability to manage multiple tasks and meet deadlines.
* Must live in Colorado
* This is a hybrid role located in Denver, Colorado with a requirement of being in the office 2 days per week.
Shift
Days (United States of America)
Work Type
Regular
Salary
$24.10 - $33.74 / hr
Benefits
At Denver Health, we take care of the people who take care of our community. Our benefits are built to support your life, your family, and your future — with generous paid time off, fully paid parental leave, exceptional retirement contributions, comprehensive health coverage, and nationally recognized well-being programs. We invest in your growth through tuition assistance, career advancement pathways, and professional development — while also offering meaningful financial advantages through loan forgiveness eligibility and employer contributions. When you join Denver Health, you’re joining a mission-driven organization that invests in you.
Here is a small list of our benefit programs:
Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays
100% paid parental leave up to 6 weeks
Immediate eligibility for retirement plans with employer contribution up to 9.5%
Generous medical, dental, vision plans in addition to employer paid disability and life…